The Research on Acupuncture Anesthesia Based on fMRI

doi:10.4236/eng.2013.510B112

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Engineering, 2013, 5, 545-548

http://dx.doi.org/10.4236/eng.2013.510B112 Published Online October 2013 (http://www.scirp.org/journal/eng)

The Research on Acupuncture Anesthesia Based on fMRI

Jijun Tong1*, Jin Liu1, Yingying Lv2, Huade Chen2

1College of Information, Zhejiang Sci-Tech University, Hangzhou, Zhejiang

2The Third Clinical Medicine College, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang

Email: *[email protected]

Received 2013

ABSTRACT

Pain is one of the most important sensations in daily life, and the traditional Chinese medicine such as acupuncture has

shown great potential in pain relief. The principle research of acupuncture anesthesia has been the focus of modern

science. In this paper the noninvasive brain imaging technique fMRI (functional magnetic reso nance imaging) was used.

Eight volunteers were enrolled and received pain stimulation, and the brain response under TEAS (transcutaneous elec-

trical acupoint stimulation) and manual needle stimulation were observed. The research finds pain has specific sensation

region and the acupuncture anesthesia is realized through modulating the corresponding brain function region, but the

manual needle has wider brai n r e sponse region tha n TE A S.

Keywords: Acupuncture; Anesthesia; fMRI

1. Introduction

Pain is one of the most important sensations in daily life.

Pain perception is much more complicated than any other

human perceptions. Much research results in many fields

have shown that pain is not only physical experience but

also closely related to many other factors such as physi-

ology, social background, cultural differences and mental

state [1]. The official definition of pain by the Interna-

tional Association for the Study of Pain (IASP) consists

of three elements: 1) it is associated with “injury” and

“threat of injury”; 2) it is an “unpleasant” and “emotional”

experience; and 3) it is “subjective” [2]. Since the Inter-

national Association for the Study of Pain was founded

in 1974, the research on pain developed steadily. But up

to present the research and control on pain is still quite

deficient. In contemporary medicine, acupuncture is con-

sidered an important adjuvant treatment and has attracted

more and more attention. Especially in anesthesia, acu-

puncture was used more widely. Acupuncture was first

successfully used in surgical analgesia in the 1950s [3].

In recent decades multidisciplinary experts explore the

principle of acupuncture analgesia from the multi-level

(from molecular and cellular level into gene level) and

multiple perspectives (nerve, body fluids, meridian) [4].

The research of mechanism of acupuncture analgesia

has become more and more important. The Traditional

Chinese Medicine is difficult to explain many acupunc-

ture phenomenons, so the use of modern medical tech-

nical in acupuncture treatment has become the research

focus in recent years, especially the various noninvasive

brain imaging technologies and their application in illu-

strating the cerebral mechanism of acupuncture anesthe-

sia. It is a huge progress in revealing the scientific es-

sence of acupuncture therapy effect [5-8]. These tech-

niques mainly include Electroencephalograph (EEG),

Magnetoencephalograph (MEG), Positron Emission To-

mography (PET), Functional Magnetic Resonance Im-

aging (fMRI) and s o on.

The paper applies Functional Magnetic Resonance

Imaging to study brain activity changes in the different

stimulation modes in LI.4 (Hegu acupoint). From a new

aspect to discusses the analgesic effect in different acu-

puncture stimulation modes, to provide the visible and

objective criterion for clinical application of acupuncture

analgesia.

2. Methods

2.1. Subjects

Eight healthy volunteers were enrolled in the experiment

(four male and four female), they are right handed, 22 -

28 years old. All volunteers were students in the univer-

sity, none of them had neurological or psychological dis-

orders and they were not taking medicine. All volunteers

were informed and received acupuncture treatment,

signed an informed consent of this experiment. The vo-

lunteers had no fMRI contraindications, such as metal

prosthet i c l i mbs, joint, heart pacemakers, etc.

*Corresponding a uthor.

J. J. TONG ET AL.

546

2.2. Experiment Materials

1) Acupuncture needle (contain gold 75%), length 40

mm, diameter 0.32 mm, Suzhou Hua Tuo factory pro-

duction. Remove the metal wire which wrapped around

the needl e s handle;

2) 75% alcohol, disinfection cotton-wool, medical pa-

per tape;

3) Siemens 1.5 T Magneton Sonata. Provided by Ra-

diology Department of the Second Hospital affiliated

Zhejiang University;

4) Black eye shade, rubber ear plugs.

2.3. Protocol of the Experiment

Each participant should attend two experiments, after

given the pain stimulation we use electrical stimulation

and manual needle stimulation in LI.4 (Hegu acupoint).

The two stimulations were given by random. For elimi-

nate other factors disturbance, the time of interv al of this

two experiments is a week for the same volunteer.

In the experiment we use 75% alcohol cotton to disin-

fect acupoint, let the volunteers on the operation stage,

using black eye shade and rubber ear plugs to cover eyes

and ears. Using a magnetic resonance special mat padded

the occipital and then using a pair of special sponge pad

plug the each side of head and fixed the head.

This experiment process was shown in Figure 1. Ac-

cording to the acupuncture program this experiment di-

vided into four stages. The first 3 min as B phase (resting

phase) and the pain stimulation last for 2 min as P phase

(pain phase), after 10 min acupuncture as S phase (sti-

mulate phase), the last 3 min after needle as PO phase

(resting phase 2). The whole process lasts for 18 min.

All subjects received pain stimulation by injection 3.5

ml mixture of herb medicine (angelica, a clinic medicine

used widely in China) and Vit.B12 (2:1) in the subjects’

left shoulder , the depth w a s about 2.5 cm.

2.4. The Experiment Stimulating Patterns

Acupuncture pattern: 1) Manual needle sti mulation, which

was operated by my professional doctor; 2) TEAS sti-

mulation: Transcutaneous electric acupoint stimulation

(HANS: Han’s acupoint nerve stimulator, Model LH202H

TEAS) was used. The stimulation frequency of TEAS

was 2/100 Hz and the intensity was 3 - 8 mA, according

to the standard to cause muscle shiver. Stimulation pat-

terns were shown in Figure 2.

2.5. The Pain of VAS Score Record

Visual Analog Scale (VAS) for all volunteers, records

Baseline(3 min) Pain(2 min) TEAS(Needle)(1 0 min) Post(3 min)

Figure 1. The process of experiment.

Figure 2. The acupuncture patterning of experiment ((A)

TEAS; (B) Manual needle).

every volunteer’s pain score after give injection stimula-

tion and after treatment.

2.6. fMRI Data Processin g

fMRI techno logy is based on brain activity caused by the

change of physiological or metabolic changes. It is very

sensitive to the blood flow and the blood oxygen level.

The spatial resolution is only a few millimeters and time

resolution is also a few seconds [9]. The statistical para-

meter mapping (SPM) was used for brain imaging data

processing [10-13].

3. Results

3.1. The VAS Score

The VAS score of each experiment was recorded. The

VAS of the manual needle group (Mean ± SD) was 5.73

± 2.28, after Manual needle stimulation treatment was

1.63 ± 1.11, The VAS of TEAS group was 5.15 ± 1.84,

after transcutanclus electrical acupoint stimulation the

VAS was 1.1 3 ± 0.48. The VAS values of the two groups

were significantly decreased after acupuncture treatment,

as shown in Table 1.

3.2. The Analyses of the Activated Brain

Functional Areas

After the pain stimulation and acupuncture treatment

(manual needle and TEAS) the corresponding brain areas

would be activated. The definition of activated areas:

mor e than 5 voxels (body element) activation, confidence

level is 0.05.

1) The activated brain functional areas after the pain

stimulation

According to the Broadmann partition, when the body

received the pain stimulation the activated brain areas

mainly distributed in: 1) the first somatosensory cortex of

postcentral gyrus (BA 3, 1 and 2) and postcentral gyrus

(BA 40), precentral gyrus, paracentral lobule; 2) the post

nodules of thalamus and left thalamus; 3) the right ven-

tral lateral nucleus and the right side of the ventral post-

erolateral nucleus; 4) bilateral superior temporal gyrus

(BA 38) and transverse temporal gyri; 5) bilateral supe-

rior temporal gyrus, middle frontal gyrus, inferior frontal

J. J. TONG ET AL.

547

Table 1. The vas value of the two groups.

Experiment group After pain stimulation

(Mean ± SD) After treatment

(Mean ± SD)

Manual needle group 5.73 ± 2.28 1.63 ± 1.11

TESA group 5.15 ± 1.84 1.13 ± 0.48

gyrus and medial frontal gyrus; 6) bilateral suboccipital

back, occipital visual cor tex (BA 18 and 19), the right of

superior occipital gyrus; 7) caudate nucleus; 8) the right

of lenticular nucleus, the right of red nucleus; 9) lateral

globus pallidus, geniculate body, corpus callosum. Acti-

vated areas were shown in Figure 3.

2) The activated brain functional areas after Manual

needle stimulation

Figure 4 shows the activated brain functional areas

after the needle stimulation on LI.4 (Hegu acupoint). 1)

central vault gyri and the left of vault gyri; 2) precentral

gyrus and the left of postcentral gyrus; 3) angular gyrus,

the corpus callosum and inferior corpus callosum; 4)

bilateral cingulated gyrus, the left of caudate nucleus and

the left of fusiform gyrus; 5) the left of superior temporal

gyrus, the left of transverse temporal gyri and supramar-

ginal gyrus; 6) the left of parietal lobe, inferior parietal

lobule and the left of precuneus; 7) the left of hippocam-

pus and hippocampal gyrus, the left of lingual gyrus,

uvula, the right of middle occipital gyrus and the right of

pulvinar thalami; 8) the right of BA partition 11, 13, 28,

34, 43, the left of BA partition 3, 7, 19, 30, 31, 36, 41,

44.

3) The acti v ated brain functio nal areas after TEAS

After the TEAS treatment the brain activated area

mainly distributed in: 1) the right side of the main bila-

teral occipital lobe visual cortex (BA19); 2) the left of

precuneus; 3) the left of superior parietal lobule; 4) the

right of BA partition BA 30, 31, and 34. As it was shown

in Figure 5.

4. Discussions

In this paper we established the pain model in healthy

people and used the blood oxygen levels dependence

functional MRI (magnetic resonance imaging) technolo-

gy to observe the brain functional areas activation after

the TEAS and manual needle stimulation in LI.4 (Hegu

acupoint). The paper explored the neurological basis of

meridian contact and communication and the principles

of acupuncture treatment to investigate the mechanism of

acupuncture analgesia.

In the experiments we found after stimulation of all

volunteers’ pain perceptions and response activities al-

most involve the whole brain, including part of thalamus,

hypothalamus, reticular formation of brain stem, limbic

system, cerebral cortex and other parts. After manual

needle stimul a tion on LI.4 (Hegu acup oint), t he activated

Figure 3. The fMRI of brain functional areas activation

after pain stimulation.

Figure 4. The fMRI of brain functional areas activation

after needle stimulation hegu acupoint.

Figure 5. The fMRI of brain functional areas activation

after transcutanclus electrical acupoint stimulation.

brain function area is mainly distributed in: precentral

gyrus, the left of inferior corpus callosum, the right of

thalamus, middle occipital gyrus, the right of cingulate

gyrus, the left of caudate nucleus, fusiform gyrus, hippo-

J. J. TONG ET AL.

548

campus, the left of superior temporal gyrus, middle tem-

poral gyrus, supramarginal gyrus, angular gyrus, left of

the superior parietal lobule and inferior parietal lobule.

But after the TEAS on LI.4 (Hegu acupoint), the acti-

vated brain functional area is mainly distributed in: the

right side of the main bilateral occipital lobe visual cor-

tex (BA19), anterior cingulated, hippocampal gyrus, left

of the precuneus and the BA partition of 30, 31, 34. Ma-

nual needle stimulation and transcutaneous electrical sti-

mulation of acupuncture analgesia through activate the

multiple brain areas related pain modulation and then to

realize, but manual needle stimulation activation area is

wider than TEAS, and the degree of activate is stronger.

5. Conclusion

Studies have shown that acupuncture (manual needle

stimulation and TEAS) is an effective means in pain re-

lief. Acupuncture analgesia mainly through activating the

multiple brain areas related pain modulation, but the ac-

tivated brain functional area is different between TEAS

and manual needle stimulation. Transcutaneou s electrical

acupoint stimulation mainly activated the right side of

the cerebral cortex-based, while the ordinary manual need-

le stimulation activated the wider areas.

6. Acknowledgements

The research was supported by the Natural Science

Foundation of Zhejiang Province. The authors would like

to appreciate their thanks to them.

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